Wednesday 20 August 2014

Five pre-exam dreams

Dialysis during war
In this dream, we are at war. It's not clear where the war is, but it instinctively feels somewhere tropical. Everything is green and lush, and the air feels humid and sticky.

I am the commander of a unit, and we are all wearing camouflage gear. We run through the low lying bushes, intermittently meeting enemies and exchanging fire with them. It all seems like a game.

Then it is night and we are back at the army barracks. It is a simple building that looks like a warehouse with high ceilings, the dim lighting provided by several naked lightbulbs. Bunkbeds are lined up down one side, strewn with rough looking blankets.

B is there with a machine that she has propped up on her bed. I walk closer and realise it is a dialysis machine, though much smaller than ones usually in clinical use. She has a fistula on her left forearm, which she is cannulating with the buttonhole technique. She hooks herself up to the machine and it hums with a low frequency. It is the only noise among the dead quiet of the night.

Later she comes up to me and says - I think there is a problem with the dialysis machine, I don't feel well. We discuss this for a while, and I tell her that whilst ideally we should do a Kt/V to figure out her urea clearance we don't have access to those facilities.

Then it is the next day, and the two of us leave the army barracks. she is carrying her dialysis machine and I am carrying some sort of machete. We walk through the fields and I tell her to protect herself and the machine at all costs, but strangely we come across no-one.

We see a subway station and go down some steps. It is a subway station of the No. 9 subway line in Shanghai, and when we first enter it appears completely deserted. The wind travels through the underground gently, scattering small piles of dust and rubbish which have collected. We walk around looking for some sort of entrance to the tracks, wondering if a train would come. Then we realise that there are a number of ATMs around which are still on, their lights flickering intermittently. Then we see people dashing out from the darkness, standing in front of the ATMs for just a few seconds before disappearing back into the darkness.

There is an ominous feeling and my alertness is heightened. We stand next to one ATM waiting for the bank advertisements to change. Then a man comes out from the darkness and says - what are you looking for? these machines are the very last connection we have to the Internet.

Then I wake up.

Tourism in Tonga 
In this dream I am in the Tongan jungle. The foliage is dense and there is barely any light on the jungle floor. The giant tree roots are gnarled and twisted around my feet, tempting me to fall. The mud is thick and black, splattering carelessly onto my clothes. The air has an incredibly intense scent of decay and regrowth, and the whole place feels alive - as if I am inside a giant living being.

Pausing for a second, I can see all sorts of insects scattering around, and I become acutely aware of leeches sliding up my legs, crawling silently as they suck on my blood.

I am with two local men who are dressed in Steve Irwin khakis that look frankly ridiculous on their thick Melanesian frames. They are also wearing explorer hardhats which are comically lopsided on their large heads. Practically bursting out of their ill fitting uniforms, they are both drenched in sweat.

We are traversing a ravine when I slip and almost fall to the bottom. They rush to my aid and I stand up straight again, amused by how overwhelming the environment is, and struck by the feeling of utter isolation.

Thank you so much for coming, they say, clearly the footpath will be very helpful in this part of the track. I chat with them a little more and find out that we are mapping out the route for a walk that will go all the way around the island of Tonga. They tell me that the tourism industry has been failing due to all the tourists going to other pacific islands. They are hopeful that this new exotic challenging walk will bring lots of tourists in.

A walk here? I wonder, looking up at the foliage which is so dense that no trace of the sky is discernible.

Then I wake up.


My face! My face!
In this dream I am rinsing my mouth in the sink in my own bathroom at home. Small flecks of corn come out and I wonder, I must have eaten some corn and it got stuck in my teeth.

With the water running, I keep rinsing and the corn keeps coming. Suddenly they turn into small specks of meat that resemble mince. I am puzzled by this - I haven't eaten meat for months, how did this meat get into the sink?

As I keep rinsing, I wonder if something has happened to my brain and I am not able to perceive the feeling of having food remnants in my mouth - how can this much corn & meat come out and I have no idea where it's stuck?

The specks of meat start getting bigger, and soon they look like blobs of meat. They get bigger still until they look like those stirfry strips you buy at the supermarket.

Just what in the world is going on? I think. I look up at the mirror and realise with a start that my face is disintegrating and the strips of meat in the sink are my face. I try to grab the last strip, a good chunky one as it starts to gurgle down the drain.

My face! My face! I scream silently in the dream. Then I wake up.


A difficult intubation
In this dream, A and I are called urgently by a nurse to Blue ICU. We go into bed 35 and there is a man there who looks very unwell. K is at the top end holding a mask on his face, so we turn around and start getting drugs and equipment ready to intubate him.

Next thing we know, K has already started the intubation without equipment or drugs. With the laryngoscope in his mouth, the patient starts struggling like crazy, trying to punch her with both his arms. She manages to duck the punches in between looking in his mouth, and shouts out for a bougie. The man starts bucking up and down on the bed, trying to squirm away from her. The nurses hand K a coat hanger and she shoves that into his mouth. We watch silently, utterly horrified as she manages to somehow get the tube over the coathanger.

Intubated, the man stops struggling and the chaos seems to have abated. She is bagging him with zest and his colour improves. Then there is water coming out from his mouth, pouring down the side of his neck, over his chest and down onto the ground. The water is coming so fast that the puddle on the ground expands rapidly.

I start to think about the implications of this if the electronic equipment were shortcircuited - or worse, if we were all electrocuted.

What's happening? I shout to K. but she is so engrossed in the bag that she doesn't reply or look up.

My eyes follow the trail of water from the ground up and as it tracks across his body back into his mouth and the bag, I realise the bag is attached to a piece of garden hose. Following the hose away from the patient, I realise that it is attached to the cold water tap, and she is bagging him with tap water!

Then I wake up.




RPA shopping centre
This is a very brief dream where I leave the ICU and walk outside to the foyer. I am looking for a ward (6E2? I can't remember) but when I walk up the stairs RPA has turned into a shopping centre and all the wards have become hidden within shops. I give up looking for the ward and go back down to ICU which looks exactly the same.

Then someone asks me if I've organised the RMO dinner and I say I haven't even thought about it, but it should be easy since we are now in a shopping centre! I go back into the shops and start looking around for restaurants. I come across quite a few but they are all closed.

I feel annoyed and think, what sort of shopping centre is this, nowhere to eat! Then I wake up.


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